Intake forms for THERAPY clients (please select your respective therapist from the dropdown menu for each form):
New client information & consent for services
To be completed for all new patients
Evaluation Acknowledgement
To be completed for all new patients
Privacy notice
To be completed for all new patients
Credit Card Authorization
To be completed for all new patients
Adult – background & history
To be completed by patients over the age of 18
Couple – background & history
To be completed by patients over the age of 18
Adult – permission to release information
To be completed by patients over the age of 18
Eating Disorders/Disordered Eating Addendum
To be completed by clients or the parents/guardians of minor clients dealing with eating disorders or dysfunctional eating
Perinatal Addendum
To be completed by patients over the age of 18
Minor – background & history
To be completed by the parents or guardians of children under age 18
Minor – permission to release information
To be completed by the parents or guardians of children under age 18